Mid-Year Formulary Changes: When Insurance Drops Your Medication

You have been taking the same medication for months. Your insurance has been covering it. Now, suddenly, they are saying it is no longer on their formulary. Can they do this in the middle of the plan year?

The answer depends on the type of change and the reason for it. Insurance companies cannot make arbitrary formulary changes during a plan year, but they can make certain modifications under specific circumstances. Understanding the rules governing mid-year formulary changes can help you determine whether your insurer is acting appropriately and what your options are for maintaining coverage.

Ellen can help you understand formulary change notices and appeal inappropriate mid-year coverage removals. Start here →